Facility Evaluation Report

Licensing Program Analysts (LPA) Gary Tan initially met with staff Simon Orve for a One (1) Year Required - Infection Control visit for this facility. Staff called who called the administrator Oliver Domingo and arrived twenty (20) minutes later. LPA explained the reason for the visit.

A tour of the physical plant was conducted at 9:10 AM and the following was noted:

There is only one entrance being utilized at the facility, there are required poster posted at the main door. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. LPA was screened upon entry. All staff were observed to be wearing mask upon entrance and during visit.

The facility had submitted and approved Mitigation plan.

Signs to wear a mask and other Covid 19 prevention protocol signs were posted outside the doors. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. The facility has a designated visitors' area at the backyard. The facility has sufficient stock of PPE in the storage room.

The facility has five (5) bedrooms and two (2) bathrooms currently occupying four (4) residents. One (1) bedroom is designated for staff use. The facility is fire cleared for four (4) non-ambulatory residents, all of which may be bedridden and two (2) ambulatory residents only. Hospice waiver for six (6) residents